Introduction: Data about Hodgkin Lymphoma (HL) in developing countries are scarce. In 2009, a prospective registry of HL was implemented in Brazil.
Methods: Twenty institutions take part in the registry. Clinical, treatment and outcome data were prospectively collected in a web-based platform, and are reported here for the first time.
Results: 756 HL patients (pts) with diagnosis until December 31, 2014 were identified. Twenty-one pts with nodular-predominant HL, 11 pts younger than 13 years-old and 38 pts with HIV were excluded, with 686 pts available for this analysis. Median age was 30 years-old (13-90); 67 (10%) pts were older than 60. Females comprised 346 pts (50%). Median time from onset of symptoms to diagnosis was 6 (0-60) months. Forty-four (7%) pts had limited disease, 180 (26%) had intermediate disease and 445 (65%) had advanced disease by GHSG criteria. Stage IVB was present in 26%, B symptoms in 69%, low albumin in 63% and a high-risk IPS score in 38%.
Median time from diagnosis to beginning of treatment was 0.72 months (0-10.87 months). Median follow-up was 37 months (0.53-94) for all patients, and 40 months (4-94) for patients alive. ABVD was the first-line treatment in 93% of pts.
Twenty-one patients died during treatment. After completed treatment, the complete remission (CR) rate was 73%, unconfirmed CR was 12%, partial remission was 4%, stable disease was 2% and progressive disease was 9%.
Among those who received ABVD, the median number of cycles was 4 for limited and intermediate and 6 for advanced disease. Radiotherapy (RT) was used in 33% of advanced disease pts, 65% of intermediate disease pts, and 77% of limited disease pts. The median dose of RT was 36 Gy for localized disease, and 32 Gy for advanced disease. The median time from the end of chemotherapy to the beginning of RT was 1.7 months.
The 3-year OS and 3-year PFS were 90% and 74%, respectively. The 3-y PFS in limited disease, intermediate disease and advanced disease were 95%, 88% and 66% (p<0.0001), respectively. The 3-year OS for limited disease, intermediate disease and advanced disease were 100%, 96% and 86% (p=0.0001), respectively.
Conclusions: Advanced stage and poor risk patients predominated. Radiation doses used for localized disease appear higher than current recommendations. Outcomes for advanced disease appear to be 5-10% lower than in developed countries, in part due to very advanced disease at diagnosis, and to an excess of deaths during treatment.